ARVs and Gender in Uganda

1. ARVs and Gender in Uganda Lisa Ann Richey Dept. of Society and Globalisation Roskilde University, Denmark richey@ruc.dk

2. The Politics of Access to Antiretrovirals in the Treatment of African AIDS Supported by the Danish Development Research Council (2005-2010) • The Western Cape Province of South Africa-a township AIDS clinic (from June until December 2005) • The Central Region of Uganda- (Aug-Sept. 2007, Dec-Jan 2008) • Research assistance and collaboration with Elizabeth Seabe, Lara Knudsen, Phoebe Kajubi, and the Working Group on the Social and Political Aspects of AIDS in Uganda

3. What links Uganda and South Africa? Sign from a Ugandan hotel

5. Points of intersection between ARV treatment and pregnant women • (1) pregnant women are to be given ARVs for the prevention of “maternal-to-child transmission” of HIV; • (2) pregnant women are meant to provide an entry point to family care and • (3) pregnant women are entitled to ARVs as a means to extend their own lives for the sake of preventing AIDS orphans

6. Do women become pregnant while on ARVs? • YES, according to counselors in both South Africa and Uganda • ‘VERY many! If you want a book, I can write it for you’– one Ugandan ARV counselor • Is it OK for women to fall pregnant on ARVs? • Depends on their needs and abilities

7. Counseling

8. A South African counselor to her clients • The drugs are not forced on people . . . the reason why we don’t push people on these drugs is because it is a lifetime commitment. You are both young, and maybe one day you will want children. If the girl wants the drugs then she will have to hear all about what she must know. She must take her drugs every day. The virus is so clever that if you skip one day the virus will build resistance. The drugs suppress the virus . . . you’re rebuilding your body and it becomes strong and the patient will live longer. These drugs we’re going to give her are three different regimens: two you take twice a day and one at night. But if you decide that you want to have children, we will take out the one at night and replace it with nevirapine. • But you must stay together. Talk together and come and sit down with the doctor so that you can have the chances explained. If you [referring to the husband] are HIV negative again then your chances are higher to get a child. You can be referred to a fertility clinic, and they will explain your chances of getting a child. Nancy has told the doctor that she doesn’t need a baby now, so it’s OK to start her on these three regimens. She cannot fall pregnant taking Stavodine because it can affect the pregnancy. This is why she is supposed to use contraceptives. If can becomes pregnant, the child won’t be normal.

9. Uganda: Shifts from Prohibition to Pragmatism • ‘To get a child is a right of every woman so long as you are mature, there is no way you can prevent that right. However, we encourage them to see their doctor first before they get pregnant to see how is the viral load and the CD4 count and can she maintain that pregnancy. . . If only both the husband and wife can come in together to see the doctor so that he can advise them. . .’

10. ‘Social Issues’, Poverty and Gender • In Uganda, the most difficult challenge that counselors reported facing in their work was the negotiation of the complex ‘social issues’—socio-economic problems, orphans, discordant couples, and pregnant clients

12. The way forward? ongoing clinic challenges in areas of poverty alleviation (requests for out-of-system support) and gender relations (discordant couples, stigma, pregnancy) Clear and pragmatic policies on ARVs and pregnancy Professional boundaries for ARV counselors Appropriate referral systems and the institutions necessary to handle the ‘social issues’ of Ugandans living with AIDS